The associations among childhood trauma, loneliness, mental health symptoms, and indicators of social exclusion in adulthood: A UK Biobank study

AIMS

Childhood trauma has been associated with adult psychosocial outcomes linked to social exclusion. However, the strength of these associations in the general population is unknown. The emergence of the UK Biobank, with rich phenotypic characterization of the adult population, affords the exploration of the childhood determinants of adult psychopathology with greater statistical power. The current study aims to explore (1) the associations between childhood trauma and social exclusion in adulthood and (2) the role that self-reported loneliness and symptoms of distress play in the associations.

METHODS

This study was an analysis of 87,545 participants (mean [± SD] age = 55.68 [7.78], 55.0% female, 97.4% White) enrolled in the UK Biobank. Childhood trauma was determined by the five-item Childhood Trauma Screener. Current loneliness and symptoms of anxiety (Generalized Anxiety Disorder Scale-7) and depression (Patient Health Questionnaire-9) were also entered in analyses. Outcomes were "limited social participation," "area deprivation," "individual deprivation," and "social exclusion" from a previously determined dimensional measure of social exclusion in the UK Biobank.

RESULTS

Hierarchical multiple regression models indicated small associations between childhood trauma and social exclusion outcomes, explaining between 1.5% and 5.0% of the variance. Associations weakened but remained significant when loneliness, anxiety, and depression were entered in the models; however, anxiety symptoms demonstrated a negative association with "individual deprivation" and "social exclusion" in the final models. Depression was most strongly associated with "individual deprivation," "area deprivation," and "social exclusion" followed by childhood trauma. Loneliness was most strongly associated with "limited social participation."

CONCLUSIONS

Experiences of childhood trauma can increase the propensity for adulthood social exclusion. Loneliness and symptoms of depression attenuate but do not eliminate these associations. Anxiety symptoms have a potentially protective effect on the development of "individual deprivation." Findings add to the growing body of literature advocating for trauma-informed approaches in a variety of settings to help ameliorate the effects of childhood trauma on adult psychosocial outcomes. Further research, however, is required.

Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

OBJECTIVES

Physical distancing, defined as keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs).

METHODS

Six databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.

RESULTS

Six articles (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors.

CONCLUSIONS

The evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.

Examining the Factor Structure, Reliability, and Validity of the Disturbing Dreams and Nightmare Severity Index (DDNSI) Consequences Sub-component

Background: The Disturbing Dreams and Nightmares Severity Index (DDNSI) is commonly used when assessing the experience of nightmares. It comprises two parts examining i) chronicity and ii) nightmare consequences. The primary aim of the present study was to explore the dimensional structure of the optional and currently unvalidated nightmare consequences component using exploratory factor analysis. Internal reliability and construct validity were also examined. A secondary aim explored the relationships between nightmare chronicity and perceived consequences with measures of anxiety, depression, stress, self-efficacy, and insomnia.Methods: A cross-sectional survey was conducted with complete data from N = 757 students from six UK-based universities. Participants completed the chronicity and consequences components of the DDNSI, alongside the Sleep Condition Indicator, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Stress Scale, and General Self-Efficacy Scale.Results: Two nightmare consequences factors emerged; 'Sleep-Interference' (four items; α =.848), and 'Psychosocial Well-being' (six items; α =.946). Significantly moderate correlations were observed between the two emerging factors and the nightmare chronicity component, as well as with insomnia, anxiety, depression, perceived stress, and self-efficacy. Perceived 'Sleep-Interference' (β =-.241) was the strongest predictor of insomnia, and 'Psychosocial wellbeing' was the strongest predictor of anxiety (β =.688) depression (β =.804) perceived stress and lower self-efficacy.Conclusions: The perceived nightmare consequences component of the DDSNI is a multidimensional construct comprising two internally consistent and distinct, but related dimensions. The potential importance of distinguishing between types of perceived nightmare consequences and the associations with mental health outcomes in a student population is highlighted.

Examination of sleep health dimensions and their associations with perceived stress and health in a UK sample

BACKGROUND

Sleep health is a relatively new multidimensional concept, however, there is no consensus on its underlying dimensions. A previous study examined potential indicators of sleep health using an aggregated sleep health measure. However, the psychometric properties are yet to be determined. The primary aim was to assess the factor structure, reliability and validity of this measure. A secondary aim was to explore the relationships with perceived stress, and physical and mental health.

METHODS

A cross-sectional online survey was conducted with 257 adults from the UK aged 18-65 (78.4% female, mean age = 29.39 [SD = 11.37]). Participants completed 13 Sleep health items, the Pittsburgh Sleep Quality Inventory, Insomnia Severity Scale, Epworth Sleepiness Scale, Perceived Stress Scale and SF-12 Health Survey.

RESULTS

The measure exhibited good internal consistency (α = 0.785) and construct validity as determined by associations with existing measures. Principle components analysis produced four factors e; sleep quality (α = 0.818), sleep adaptability (α = 0.917), sleep wellness (α = 0.621) and daytime functioning (α = 0.582). Adaptability (β = -241) was strongest predictor of perceived stress, and daytime functioning was strongest predictor of physical (β = 0.322) and mental health (β = 0.312).

CONCLUSIONS

Sleep health is a multidimensional construct comprising four distinct but related dimensions. The importance of sleep health in terms of perceived stress and mental and physical health is highlighted.

The role of the COVID-19 pandemic in altered psychological well-being, mental health and sleep: an online cross-sectional study

Coronavirus disease 2019 (COVID-19) is a global pandemic. Measures to reduce transmission of the virus have altered usual activities, routines, and livelihoods, and have had a significant impact on mental health. The current study aims to examine the potential alterations in psychological wellbeing, mental health, sleep and diurnal preference due to the COVID-19 pandemic. A cross sectional online questionnaire-based study with n = 200 participants (aged 18-62; 7.86.0% female, 93.0% white, 92.5% UK-based, 73.5% students). Data were collected between 15^th April and 8 June 2020. Participants answered questions on lifestyle changes and their concerns and worries about COVID-19, and completed the SCI, PHQ9, GAD7, PWB18, UCLA3 and MEQ. Results showed self-isolation was linked to lower psychological well-being, and increased loneliness, anxiety and depression. Home-working was related to a shift in diurnal preference. Reduced work/income was related to decreased psychological well-being and sleep quality and increased anxiety, depression, loneliness and. Intensity of worried thoughts and concerns about COVID-19 were positively correlated with anxiety, depression and negatively with sleep quality. In conclusion, the social, occupational and economic disruption due to COVID19 has had a negative impact on psychological well-being. However, the transition to home-working may have been somewhat beneficial for some individuals in terms of sleep. These findings should be taken into account by policy makers during the transition to the 'new normal' post-pandemic.

Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis

OBJECTIVE

To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes.

METHODS

Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported.

RESULTS

Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c.

CONCLUSION

All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.

The associations between loneliness, social exclusion and pain in the general population: A N=502,528 cross-sectional UK Biobank study

Chronic pain presents a huge burden for individuals and society and evidence suggests intrinsic links with loneliness, social exclusion and sleep. Research examining how these factors interact is warranted. We aimed to explore the relationships between social exclusion, loneliness, acute and chronic pain, and the influence of poor sleep, in the general UK population. A cross-sectional analysis of UKBiobank participants with baseline data for acute and chronic pain, loneliness and sleep. Principal components analysis (PCA) used data relating to social isolation and deprivation to establish a composite measure of social exclusion. Binary logistic regression analyses were performed. 502,528 UKBiobank participants (mean age = 56.6years, 54.4%female, 94.6%white) were included in the analysis. PCA suggested three social exclusion factors "social participation", "individual deprivation" and "area deprivation". Loneliness significantly predicted acute (OR:1.887; 95%CI1.857-1.917) and chronic pain (OR:1.843; 95%CI1.816-1.870). Each social exclusion factor alone and in combination significantly predicted pain with largest effects for individuals scoring high on all social exclusion factors, for acute (OR:2.087; 95%CI2.026-2.150) and chronic (OR:2.314; 95%CI2.249-2.380) pain. Coefficients remained statistically significant when models were adjusted for demographics and sleep. Social exclusion (as a multifaceted construct) and loneliness are associated with an increased prevalence of acute and chronic pain. Poor sleep has a potential mediating effect on these associations. Exploration of the incidence of pain in loneliness and social exclusion in the general population is warranted. From a public health perspective these findings could be used to design social interventions to prevent or manage pain and mitigate social exclusion.

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

OBJECTIVE

Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND).

METHODS

Prospective observational design. Clinical cohort study among consecutive outpatients with DSM-IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient-related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome.

RESULTS

A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, β = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, β = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, β = 0.435, p = .008) outcome.

CONCLUSION

Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.

Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals

Therapeutic writing can enhance psychological and physical health. Recent studies have suggested that these kinds of interventions can be effective when delivered online. The present study investigated whether positive emotional writing online can influence psychological and physical health in individuals reporting high levels of negative affectivity, who are most likely to benefit from psychological intervention (N = 72, M_age = 28.5, SD_age = 8.7), and further, to investigate the potential moderating role of social inhibition. Participants completed self-report measures of physical symptoms, perceived stress, perceived stress reactivity, depression and generalised anxiety, before completing either i) positive emotional writing, or ii) a non-emotive control writing task on an online portal, for 20 min per day over three consecutive days. State anxiety was measured immediately after each writing session, and self-report questionnaires were again administered four weeks post-writing. Socially inhibited individuals exhibited significant reductions in depression and perceived stress reactivity four weeks following positive emotional writing, relative to writing about a neutral topic. The present study supports the efficacy of online therapeutic writing in individuals who, due to their socially inhibited nature, are most likely to benefit from online interventions which avoid interaction with a therapist or other clients.

An experimental investigation into cardiovascular, haemodynamic and salivary alpha amylase reactivity to acute stress in Type D individuals

Type D personality is characterized by increased social inhibition and negative affectivity. Research demonstrates associations between Type D and poor physical health. Maladaptive sympathetic arousal is suggested as a potential mechanism, however, findings are inconsistent and studies mainly focus on basic cardiovascular parameters. The current study examines cardiovascular and haemodynamic parameters in addition to salivary alpha amylase (sAA) as markers of sympathetic stress reactivity in Type D individuals. Healthy adults (N = 75; 33 Type D; aged 18-42; 64% female) completed a multitasking stressor while continuous beat-to-beat cardiovascular function was measured. Saliva samples were obtained at baseline, pre-task, post-task, +10 min and +20 min post-task. Type Ds exhibited dysfunctional cardiovascular reactivity, characterized by blunted total peripheral resistance, slower stroke volume recovery and potentially unhealthy changes in haemodynamic profile. Alpha amylase reactivity was evident, but group differences were not significant. Findings indicate dysregulated sympathetic reactivity in Type D individuals, exemplified by a maladaptive haemodynamic profile.

The physical and psychological health benefits of positive emotional writing: Investigating the moderating role of Type D (distressed) personality

OBJECTIVES

Type D personality is associated with psychological and physical ill-health. However, there has been limited investigation of the role of Type D personality in interventions designed to enhance well-being. This study investigated associations between Type D personality and the efficacy of positive emotional writing for reducing stress, anxiety, and physical symptoms.

DESIGN

A between-subjects longitudinal design was employed.

METHOD

Participants (N = 71, M_age  = 28.2, SD_age  = 12.4) completed self-report measures of Type D personality, physical symptoms, perceived stress, and trait anxiety, before completing either (1) positive emotional writing or (2) a non-emotive control writing task, for 20 min per day over three consecutive days. State anxiety was measured immediately before and after each writing session, and self-report questionnaires were again administered 4 weeks post-writing.

RESULTS

Participants in the positive emotional writing condition showed significantly greater reductions in (1) state anxiety and (2) both trait anxiety and perceived stress over the 4-week follow-up period, compared to the control group. While these effects were not moderated by Type D personality, a decrease in trait anxiety was particularly evident in participants who reported both high levels of social inhibition and low negative affectivity. Linguistic analysis of the writing diaries showed that Type D personality was positively associated with swear word use, but not any other linguistic categories.

CONCLUSION

These findings support the efficacy of positive emotional writing for alleviating stress and anxiety, but not perceived physical symptoms. Swearing may be a coping strategy employed by high Type D individuals. Statement of contribution What is already known on this subject? Type D (distressed) personality is characterized by high levels of both negative affectivity and social inhibition, and has been associated with adverse physical and psychological health. Positive emotional writing is known to reduce subjectively reported physical symptoms and increase positive affect. What does this study add? Positive emotional writing was shown to attenuate (1) state anxiety immediately post-writing, and (2) trait anxiety and perceived stress 4 weeks post-writing. The findings demonstrate that positive writing might be a useful intervention for attenuating the adverse psychological effects of Type D personality in the general population. Type D personality was associated with more frequent use of swear words, which may be a coping mechanism used by high Type D individuals.

The relationship between Type D personality and physical health complaints is mediated by perceived stress and anxiety but not diurnal cortisol secretion

Type D personality has been associated with minor health complaints in the general population and dysregulation of basal cortisol secretion in coronary patients. The aims of the present study were to investigate (i) whether there is an association between Type D personality and basal cortisol secretion in the general population, and (ii) whether subjective measures of stress and anxiety, as well as indices of basal cortisol secretion, mediate the relationship between Type D personality and self-reported physical symptoms in this group. Self-report measures of stress, trait anxiety and physical symptoms were provided by 101 individuals aged 18-45 years. Saliva samples were also provided over two consecutive "typical" days, to enable indices of the cortisol awakening response and diurnal cortisol profile to be determined. There was a significant relationship between Type D personality and self-reported physical symptoms, which was fully mediated by subjective stress and anxiety. However, there were no significant relationships between Type D personality and the basal cortisol indices. These findings suggest that the association between Type D personality and minor health complaints in the general population can be explained by feelings of stress and anxiety, but a precise biological mechanism for this link is yet to be elucidated.

Exploration of potential objective and subjective daily indicators of sleep health in normal sleepers

PURPOSE

While the concept of "sleep health" has only recently been defined, how it relates to both subjective and objective sleep parameters is yet to be determined. The current study aimed to identify potential indicators of poorer sleep health, from subjective and objective daily sleep characteristics, in normal sleepers.

PARTICIPANTS AND METHODS

Eighty-three individuals aged 18-65 years with no history of sleep disorders, chronic physical or psychiatric illnesses, or substance misuse were recruited from the North of England. Secondary analysis of a series of standardized studies, which included psychometrics, actigraphy, and an in-lab polysomnography (PSG) component, was undertaken. Questions from several psychometric sleep scales were combined to create an aggregate measure of sleep health status. Subjective sleep continuity was assessed by 2-week sleep diary. Objective measures comprised two continuous weeks of actigraphy and two nights of in-lab PSG.

RESULTS

Significant negative correlations were evident between sleep health scores and both diary-derived subjective sleep latency (SL; diary) and actigraphy-derived SL (actigraphy). This was reflected by independent samples t-test between high and low sleep health groups. No relationships between sleep health and PSG parameters were observed. Regression analyses indicated sleep latencies from both the sleep diary and actigraphy as significant predictors, explaining 28.2% of the variance in sleep health.

CONCLUSION

Perceived increases in SL appear to be a primary indicator of declining sleep health in normal sleepers. The majority of objective sleep parameters, including gross PSG sleep parameters, appear not to be sensitive to sleep health status in normal sleepers. Future research is needed to understand the physical and psychological correlates of sleep health in larger samples.

Avoidance in trauma: conscious and unconscious defense, pathology, and health

Drawing from our work with children seen following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma, this article describes clinical aspects of avoidance in traumatized children and their families. Avoidance in traumatized children and their families seems a final common pathway arising from a number of diverse factors. The importance of particular factors for assessment and treatment is emphasized.

Integration of therapeutic approaches in working with children

Child treatment and family therapy have developed divergent theories and methods, yet each contributes concepts that benefit children and families presenting with clinical problems. The authors discuss the theories and methods for both forms of treatment and review the literature on efforts to combine these approaches. They then describe a model, illustrated with case examples, in which careful assessment and planning throughout the treatment process are used to flexibly combine individual and family therapy techniques.

Photochemical formation of singlet molecular oxygen (1O2) in illuminated aqueous solutions of p-aminobenzoic acid (PABA)

Evidence is presented for the photochemical formation of singlet molecular oxygen (1O2) in air-saturated buffered aqueous solutions of p-aminobenzoic acid (PABA) using sunlight-range illumination. This is significant because PABA is widely used as an active ingredient in sunscreen preparations that are applied to the surface of the skin and 1O2 is known to cause oxidative damage to cells via the formation and subsequent reactions of lipid peroxides. Furfuryl alcohol (FFA), a well known chemical trap for 1O2, was added to aqueous PABA solutions prior to illumination. The FFA was consumed when the solution was illuminated, but no loss of FFA occurred in the dark and loss by direct photolysis was negligibly slow. Further evidence for the formation of 1O2 in illuminated aqueous PABA solutions is provided by the results of experiments in which individual solutions containing PABA and FFA that were diluted with D2O exhibited an increased rate of FFA consumption due to the increased lifetime and concentration of 1O2 in this solvent.